Oncology & Hematology Coding Alert

Question: If a physician administers an intramuscular injection of methotrexate and also conducts an office visit, should we use modifier -25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) with the E/M service? We wouldn't normally bill an E/M service when they do a simply injection like a flu shot, but for some reason there seems to be more involved in the injection of methotrexate. For example, our doctors say that the medical decision-making is higher.

Indiana Subscriber

Answer: Yes, an E/M service can and should be billed whenever an appropriate service is performed. If your physician has billed a service that includes history, physical examination and medical decision-making to support an E/M service, he should choose the appropriate code and bill for the service.

Chemotherapy administration in and of itself does not justify a certain level of E/M service, but it certainly contributes to the complexity of the medical decision-making for a visit and should be considered as the appropriate E/M code is chosen. In addition to the E/M service, you should bill 96400 (Chemotherapy administration, subcutaneous or intramuscular, with our without local anesthesia) for the administration of the drug.